One-liner#

Most successful prior auths clearly map: indication → failure of alternatives → why the requested service is needed now.

Letter structure (fast)#

• Patient identifiers + requested service/medication (CPT/HCPCS or drug)
• Diagnosis/indication and key severity features
• Prior therapies tried (and intolerance/failure)
• Supporting data (labs/imaging, guideline rationale when relevant)
• Consequence of delay/denial

Documentation checklist#

• Alternatives tried and dates (or contraindications)
• Objective criteria the payer requires (when known)
• Follow-up plan and monitoring (especially for specialty meds)